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Psychological and Psychiatric Issues in Functional Constipation, Fecal Incontinence and Bladder and Bowel
Alexander von Gontard1, Anka Nieuwhof-Leppink2, Ubirajara Barroso3
1Governor Kremers Center, Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
Insights
Psychological and psychiatric issues are common in children with fecal incontinence (FI), functional constipation (FC), and bladder and bowel dysfunction (BBD). Early screening and assessment are crucial for effective management and improved outcomes.
Area of Science:
- Pediatric gastroenterology
- Child psychiatry
- Behavioral science
Background:
- Psychological and psychiatric aspects of pediatric functional bowel and bladder disorders are complex.
- Subclinical psychological symptoms and clinical behavioral disorders are frequently observed.
Purpose of the Study:
- To provide an updated overview of psychological and psychiatric aspects of fecal incontinence (FI), functional constipation (FC), non-retentive FI (NRFI), and bladder and bowel dysfunction (BBD).
- To outline screening, assessment, counseling, and treatment recommendations.
Main Methods:
- Review of relevant publications on psychological and psychiatric aspects.
- Consensus-finding process among International Children's Continence Society (ICCS) board members.
Main Results:
- High rates of comorbid psychiatric disorders (30%-50%) in children with FI, FC, and NRFI.
- Children with BBD are a special risk group.
- Associated psychiatric disturbances include externalizing, internalizing, and neurodevelopmental disorders, negatively impacting compliance and outcomes if untreated.
Conclusions:
- Screening for psychological symptoms is recommended for all children with FI, FC, NRFI, and BBD.
- Validated broadband behavioral questionnaires are recommended alongside clinical assessment.
- Full child psychiatric or psychological assessment is advised for children with clinically significant problems.
Purpose:
The aim is to provide an updated and revised overview of psychological and psychiatric aspects of fecal incontinence (FI), functional constipation (FC), non-retentive FI (NRFI) and bladder and bowel dysfunction (BBD). Clinical behavioral disorders and subclinical psychological symptoms are reviewed. Aspects of screening, assessment, counseling, and in severe cases, treatment are outlined and recommendations are formulated.
Methods:
Relevant publications on psychological and psychiatric aspects are reviewed. The recommendations passed several rounds of consensus finding and were circulated among ICCS board members.
Results:
In addition to subclinical effects on self-esteem, quality of life, and stress, the rate of comorbid psychiatric disorders is increased. 30%-50% with FI, FC, and NRFI fulfill the criteria for clinically relevant psychiatric disorders. A special risk group is children with BBD. The concomitant psychiatric disturbances include externalizing, internalizing, and neurodevelopmental disorders. They require assessment and counseling, in severe cases, treatment. They have a negative effect on compliance and outcome if not addressed and left untreated.
Recommendations:
Because the comorbidity rate is high, screening for psychological symptoms is recommended for all children in all settings with FI, FC, FNRFI and BBD. In addition to clinical observation, exploration and history, standardized, validated broadband behavioral questionnaires are recommended. If problem items in the clinical range are present, a full child psychiatric or psychological assessment is recommended.
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